Published: 20/06/2002, Volume II2, No.5810 Page 4 5

Health and social services leaders have joined to produce an alternative to fining local authorities for the costs of bed-blocking.

Plans to allow 'cross charging' of social services departments by NHS trusts, first revealed by HSJ in February, were published in Delivering the NHS Plan. Both the NHS Confederation and the Local Government Association have criticised the move.

The confederation and the LGA have now jointly produced an alternative model aimed at developing 'constructive incentives. . .

framed within a whole-systems approach' and aimed at promoting older people's independence.

The LGA confirmed this week that the proposals had been discussed with health minister Jacqui Smith and civil servants.

They centre on giving health and social care joint targets and increasing the priority of indicators that boost services to prevent and divert hospital admissions, along with rehabilitation, intermediate care and support at home. They include:

increasing the number of indicators designated as a shared responsibility across health and social care;

'elevating the status' of some indicators - such as delayed discharges - to 'national priorities';

giving key indicators in this system an increased weighting in social care performance assessment;

setting national targets against more of the relevant indicators and developing new targets for areas with weak coverage, such as intensive nurse support at home nuse of financial incentives 'to support above-average performance'.

NHS Confederation policy director Nigel Edwards said: 'We are coming at this through target -setting and ensuring that things are joined up, which would mean you wouldn't have to fine anyone.

'Shared performance indicators across health and social care allow you to take a proper whole-systems approach. Our main problem with fining is it only deals with one element [of the system].'

Cross-charging local councils for bed-blocking would mean social services putting effort into avoiding the fines, but not into other services for vulnerable older people, he said.

LGA health and social care programme manager Jeni Bremner said: 'The LGA is opposed fundamentally to proposals to charge.

The problem is a whole-system problem and it is inappropriate to target local government in the same way it is inappropriate to target any other part of the system.'

She stressed the importance of preventive and community services and added: 'In acute care there needs to be work to divert people from admission [to hospital].'

Ms Bremner also pointed out that in Sweden - where the crosscharging system originates - '90 per cent of residential care is provided in-house by local government'. This made it 'more straightforward' to expand capacity than in the UK, where most is in the private sector.

The LGA's social affairs and health executive voted to delete from its report a proposal for 'use of financial penalties on any single agency' to be 'reserved' for three years to 'see how well the system as a whole responds to greater incentives across the board'.